Did A Co-Worker Get You Sick? It Might Be Your Employer's Fault

Flu peaked late this season, so thousands of Americans are still battling the symptoms of influenza and dozens of other wintertime viruses at the moment. Parents of small children in particular know that each new year also brings a new crop of viruses and bacteria into the home that require them to take sick days for kids or themselves—if they have them.

And if their employer doesn’t have paid sick leave? Parents of small kids may be out of luck and out of a full paycheck that week if they can’t send their kids to daycare or school, but the other feverish, coughing, sniffling, sneezing, contagious adults who are sick will most likely go to work anyway. They’ll also delay getting medical care—or skip it altogether, found a study published in Health Affairs.

In fact, both full-time and part-time employees who don’t have paid sick leave are three times more likely than employees with paid sick leave to go without medical care for an illness, the study found. Their families suffer too: The family members of workers without paid sick leave are twice as likely to go without care and 1.6 times more likely to forgo care altogether, compared to the family members of workers with paid sick leave.

“The personal health care consequences of delaying or forgoing needed medical care can lead to more complicated and expensive health conditions,” said lead author LeaAnne DeRigne, Ph.D., an associate professor of social work at Florida Atlantic University in Boca Raton, Florida. She co-authored the study with Patricia Stoddard-Dare, PhD, and Linda Quinn, PhD, of Cleveland State University in Ohio. “We also need workers to be able to take their children to annual pediatrician appointments and for needed immunizations. Missing a day’s wages can be especially hard for low-income workers who are also the ones more likely to lack paid sick leave and to have children with special healthcare needs.”

The study notes that an estimated 49 million American workers don’t have access to paid sick leave, and it hits low-income workers particularly hard. Just three in ten low-income workers with a child “in fair or poor health” have paid sick leave benefits. Co-workers pay a price too. One study estimated that an additional 7 million people became sick during the 2009-2010 H1N1 flu outbreak because sick employees didn't stay home, resulting in an estimated 1,500 extra deaths.

DeRigne’s team analyzed data from an ongoing annual survey of 18,655 employed adults, ages 18–64, whose demographics are nationally representative of the U.S. population. The researchers didn’t include adults working without pay, working in a family business, self-employed, looking for work or unemployed.

Of the whole group, just 57% had paid sick leave benefits—which means about two in every five American workers from their survey didn’t have paid sick leave. But that second figure rose as household income fell: Only a quarter of workers with household incomes above $100,000 a year lacked paid sick leave, but 65% of those with household incomes below $35,000 didn’t have paid sick leave.

“This disparity left the most economically vulnerable without the protective benefit of paid sick leave,” the authors wrote.

Unsurprisingly, the workers without paid sick leave were three times more likely to delay medical care for themselves and twice as likely to delay it for a family member compared to those with paid sick leave, though the likelihood of seeking care shifted with insurance coverage.

“While paid sick leave was important, having insurance also had a major impact on the respondent’s forgoing needed care, especially for low-income respondents,” the authors reported. “This was true for those with and without paid sick leave benefits and across income groups.”

Even after accounting for health status, income level, education level and various individual and family demographics, however, workers without paid sick leave were less likely to seek medical care—and more likely to go to work while sick.

Adults without paid sick leave missed work an average 3.6 days a year while those with paid sick leave missed an average 5.1 days a year. That’s a 1.5-day difference, more than enough to infect plenty of co-workers.

“Paid sick leave gives workers the opportunity to self-quarantine when they are sick without the worries of losing their job or a day’s wages,” DeRigne said. “The public health implications of paid sick leave can be huge, as companies such as Chipotle are learning. That company recently added paid sick leave benefits to ensure that workers are not coming to work sick.” Chipotle reported last month that sick employees coming to work were responsible for two norovirus outbreaks that sickened other employees and customers.

New York Gov. Andrew Cuomo speaks Feb. 17, 2016, during a rally for paid family leave in New York. New York may soon join California, Rhode Island and New Jersey by allowing workers to paid take time off to care for a new child or sick loved one. (AP Photo/Seth Wenig, File)

"Workers who delay healthcare appointments end up with conditions that are more complicated and result in longer absences from work," DeRigne said. "Other research has found that having paid sick leave increases productivity at work since workers who are at work ill are less productive." Workers who can take off work for preventive care are less likely to get sick in the first place, and offering paid sick leave increases employee retention and improves morale, she added.

How much chronic illness affects productivity may depend on retention, though, said Adam Powell, Ph.D., a health economist and president of Payer+Provider Syndicate. “While delays in receiving care for communicable diseases may impact productivity at work, delays in receiving care for chronic diseases may have an impact only long after the employee has left the job,” he said.

Powell pointed out that the shift away from traditional long-term employer/employee relationships could actually lead to less paid sick leave available to workers as employers offload the cost of illness onto employees.

“However, more flexible employment arrangements may enable some to seek care at times when it is least likely to impact income,” Powell added. “Likewise, telecommuting may enable some to work while sick without the risk of harming fellow workers. Thus, more flexible work arrangements may exacerbate the problem of people having no paid sick leave but may also provide new avenues for managing illness.”

But jobs that offer perks like telecommuting tend to be higher-income jobs, and it’s low-income workers who bear the biggest burden of no paid sick leave—such as those stocking grocery shelves, serving food, working in factories or construction, cutting hair and giving pedicures. In fact, just one in five employees in the food preparation and service industry has paid sick leave, according to a report from the Institute for Women’s Policy Research. Food prep and service employees had the second lowest percentage of paid sick leave, just ahead of farming, fishing and forestry, and just behind personal care and service. Nearly half of those in healthcare support and a quarter of healthcare clinicians—doctors, nurses, technicians, etc.—don’t have paid sick leave.

The U.S. lags behind the rest of the world in this area. It’s the only country out of 22 of the wealthiest, most developed countries in the world not to guarantee all employees have paid sick leave. In fact, no U.S. laws even prevent workers from being fired if they miss work because of sickness. Only four states—Connecticut, California, Massachusetts and Oregon—mandate that employers provide workers with a minimum number of paid sick days, and federal contractors are required by President Obama to offer seven paid sick days a year.

Yet 145 other countries offer some form of paid sick days through employer requirements or national social insurance plans, according to the World Health Organization. It wasn’t until 1993 that the U.S. required businesses with more than 50 employees to offer up to 12 weeks of unpaid leave—without thread of termination—under the Family and Medical Leave Act—but that’s unpaid, and it has nothing to do with short-term sick days or preventive care visits.

“Access to paid sick leave benefits should be a guaranteed right in this country,” DeRigne said. “Working Americans should be able to balance both work and their and their family's healthcare needs. Now that so many more Americans have access to health insurance because of the passage of the Affordable Care Act we should take the next step and make sure they are able to get away from work to use it.”

I am a freelance science and multimedia journalist who specializes in reporting on vaccines, pediatric and maternal health, parenting, public health, mental health, medical research, and the social sciences. My work has appeared in The New York Times, NPR, Scientific America...